Pathology of transplanted human duodenal tissue: A histologic study, with comparison to pancreatic pathology in resected pancreaticoduodenal transplants

In an effort to define the pathology of transplanted human duodenal tissue, 15 resected human duodenal tissues transplanted as pancreaticoduodenal allografts were reviewed and compared with 12 native jejunal tissues (control tissues) used with segmental pancreatic transplants. Correlation of findings in duodenal and pancreatic tissues was also performed. Features which were present in duodenal allografts but not in control tissues included crypt loss (p = 0.0065), villous atrophy (p = 0.015) and vascular changes (endothelialitis, vasculitis and subintimal thickening). Other findings typical of rejecting duodenal allografts included epithelial cell necrosis, epithelial reactive atypia (p = 0.012), and intraepithelial inflammation. Nine patients had histologic evidence of pancreas rejection. The duodenal allografts from these 9 patients typically showed epithelial necrosis, crypt loss and villous atrophy in the mucosa. These features may be markers of acute pancreatic rejection. CMV infection in the duodenal allografts corresponded to pancreatic CMV infection in 1 of 2 allografts.